AimTo evaluate the role of ultrasonography for differentiating cervical lymphadenopathy due to tuberculosis, metastasis and lymphoma.MethodsUltrasonography of the neck nodes was carried out prior to FNAC in 192 patients using a 10 mHz linear transducer. The sonographic findings were then correlated with the definitive tissue diagnosis obtained by FNAC or lymph node biopsy.ResultsThe most significant distinguishing feature was strong internal echoes seen in 84% of tubercular lymph nodes. This finding was found in only 11% of metastatic nodes and absent in lymphomatous nodes. The other findings such as L/S ratio, irregular margins, hypoechoic center, fusion tendency, peripheral halo and absent hilus were helpful in differentiating reactive from diseased nodes but showed considerable overlap in the 3 groups of tubercular, metastatic and lymphoma lymph nodes.ConclusionUltrasonography is noninvasive and can give useful clues in the diagnosis of cervical lymphadenopathy. It should be interpreted in conjunction with FNAC result. Ideally ultra-sonographic guided FNAC should be obtained from the sonographically most representative node. In FNAC indeterminate cases, sonographic features may obviate the need for an invasive lymph node biopsy.

We present an unusual case of chordee without hypospadias with a communicating, symptomatic epidermoid cyst. A 12-year-old boy presented with painful erections, especially early in the morning, over the last year and a watery discharge from swelling located near the meatus for 2 months. On examination, ventral chordee was present, the meatus was orthotopic, the prepuce was normal, and a ~0.5X0.5 cm swelling was present near the meatus on the ventral aspect with watery discharge. During operation, it was found that this swelling had communication with the urethra, and it was an epidermoid cyst on histopathologic examination.